ascites

[bearwoman]

dx'd Aug 2010.  may start tx May/June 2011, or wait until new drugs are approved.

i'm type 1 a.  I've seen pics of ascites.  question:  does ascites come at end stage liver failure, or with cirrhosis?

have had 2 docs both of whom don't provide info.  they just want to treat with pegysis.  thank u.

[Dennisdrl1]

If ascites is present it is important to determine whether or not it is due to decompensated cirrhosis from HCV.  There are other medical conditions that can be associated with ascites.  In addition, if cirrhosis is present it is important to be screened for hepatocellular cancer as its risk is increased with cirrhosis of any cause.  The diagnosis of cirrhosis is not dependent upon a liver biopsy.  Imaging studies of the liver can make the diagnosis.   If cirrhosis is present it is important to have an upper endoscopy to screen for esophageal and gastric varices (veins that can develop which can predispose to bleeding).  The decision to treat someone with cirrhosis is dependent upon the MELD score and other factors such as platelet count.  I currently have some cirrhotics under treatment with well or mildly decompensated cirrhosis who are doing well and have a  good chance of clearing the virus.

[eureka254]

Glad that you don't have ascites, and good for you that you're keeping to a liver-healthy lifestyle.  Do you have hepatologist or GI caring for you?  How recently did you last have a liver biopsy?  It may be worthwhile to mention your itching, as though ascites usually doesn't occur with liver disease unless cirrhosis is quite progressed, there are some skin conditions that can be manifest in the presence of active hep c.

[Susan_1a_CC]

Do you know the cause of your itching?  If not, have your ammonia levels been checked?

[bearwoman]

I apologize to u all.  i do not have ascites.  Just fibrosis from liver bx.  yes, i will find out what stage 1a I have.  

I've been very diligent re: no added salt/sugar/caffeine, no red meat/dairy/soft drinks.  

But in the last 3 days I relapsed.  Had a butter/cheese baked potato, some potato chips, a whole bag of red licorice, Reuben sandwhich, etc. And one coke.  

As i type, the nightmare itch returns, slowly in the legs, then the arms, now the feet.  

I'm hoping I've learned my lesson.  Yes, milk thistle, flaxseed oil capsules, moisturizes, ice packs on my feet and the most irritating spots are my anti-itch regimen.  

In short, i can't screw around diet-wise with my liver.  Now, let's see how long it takes before this itch is under control.  crossing my fingers it does get under control.  Nuts.

thank u all for your input/imput (spelling).  Yep, brain fog abounds.  I used to be such an excellent speller too.    

[Resilient_Mimi]

I am also a Geno 1a, I was diagnosed in June 2010.  Have you had a liver biopsy yet? That will tell you what shape your liver is in now.  I think that Ascites is most common is a people that already have liver Cirrhosis, and you have to have this biopsy first to determine that. Usually, bed rest, a low salt diet, and diuretics help eliminate excess fluid, which is in the abdomen of people with Ascites. I haven't started treament yet, I'm waiting on the new medicine "Telaprevir" it is going thru FDA approval now, It supposed to be ready in June of 2011, It supposed to really help people with Geno type 1, these is the tricky one, as I'm told! It is said to "CURE" 75%  of people given along with Pegylated-interferon and ribavirin.  It also states that it can lessen the time your on treatment.  Whcich is good to hear, I'm supposed to have 48 weeks of treatment. Good luck!  Hope you have great success with your treatment!

[copyman]

do you have ascites? some good advice from hector.  perhaps your doctor wants you to treat with pegasys to give your liver a break. If you do have ascites and you treat with peg do it with the careful watch of a doctor (preferably a Hepatologist).  
Perhaps do the peg only until the new drugs come out.

[HectorSF]

First if you are not going to treat until summer you should think about treating with the new treatment med protocol which should be available about at that time. You can increase your odds of SVR by a huge margin even if you have cirrhosis. Do you have cirrhosis? Compensated or Decompensated?

Ascites is one of the most common first symptoms of decompensated cirrhosis. This is the final stage of liver disease. Ascites like the other symptoms of decompensated cirrhosis indicate that the liver is so damaged it is unable to perform all of it functions which it could earlier. Even at the stage of compensated cirrhosis when the liver is very scarred the liver is able to still perform its many functions.

ESLD (End Stage Liver Disease) is a term used by transplant centers for advanced liver disease the is used indicate how ill someone with Cirrhosis is and predicts the survival rate with the person's current liver.
Liver transplant programs use the "Model for End-Stage Liver Disease (MELD)" scoring system. MELD scores range from 6-40. For example, a MELD score between 30-39 indicates a 60% chance of death.

There is very little data regarding treatment results when a patient's liver has reached the time when ascites, edema, hepatic encephalopathy, varices and other symptoms are present. In fact it is recommended that patients with decompensated are not treated with interferon and ribavirin. Since the liver is so damaged it is possible for the very powerful meds such as interferon and ribavirin to cause liver failure. I currently have decompensated cirrhosis so what you ask about is an important topic for me personally. My hepatologist who happens to be one of the leaders in the field of hepatitis and liver disease has told me that she will treat me with the new STAT-C meds IF my MELD score is under 20. I have have the chance I will do it, but this is a very personal decision for each individual to make if you can find a doctor who is willing to do this. I realize I run the risk of liver failure. If this should happen I will need a liver transplant to continue to live. For myself, I am willing to take the risk. If you should want to do the same it is important that you are seeing a hepatologist at a transplant center who is experienced with working with patients with decompensated cirrhosis and the you are on the transplant list should something go wrong. This can be a life and death decision, that should be thought about and talked over not only your doctor but your family and your support group (close friends, etc.).

I hope this helps.
If I can be of any further help please let me know.
Best-HectorSF